Radical hysterectomy: An anatomic evaluation of parametrial dissection

Gynecol Oncol. 2000 Apr;77(1):155-63. doi: 10.1006/gyno.1999.5723.


Objectives: This study was designed to demonstrate a reduction in the amount of blood loss for vesicouterine ligament dissection and to investigate the intrapelvic autonomic nerve pathway and its preservation by means of anatomic analysis.

Methods: The anchoring mechanism of the pelvic viscera to the pelvic wall was divided into a supporting system facing laterally and a suspensory system facing dorsoventrally. An operative procedure was designed in which both systems were separated and dissected independently.

Results: Between the two systems, an artificial space was developed, which required a new dissection method for the parametrium and revealed a new anatomic pathway for the ureter and autonomic nerve. The amount of blood loss (mean +/- SD) during dissection of the vesicouterine ligament was ultimately 260.1 +/- 114.8 ml. Postoperatively, the maximum capacity of the bladder was 393.9 +/- 40.4 ml, maximum detrusor pressure 6.3 +/- 4.1 cm H(2)O, mean compliance >10 ml/cm H(2)O, residual urine 23.8 +/- 9.4 ml, and maximum flow rate 25. +/- 8 2.2 ml/s, respectively.

Conclusion: A new classification for the parametrium and its dissection method have been established. Development of this new operative procedure has also contributed to a decrease in blood loss and preservation of bladder function.

MeSH terms

  • Blood Loss, Surgical / prevention & control*
  • Female
  • Humans
  • Hysterectomy / methods*
  • Ligaments / anatomy & histology
  • Ligaments / surgery
  • Pelvis / anatomy & histology
  • Urinary Bladder, Neurogenic / prevention & control
  • Uterus / anatomy & histology*
  • Uterus / innervation
  • Uterus / surgery*